Urology

doi:10.1136/bmj.321.7273.1393

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This article has a correction

Please see: Recent advances: Urology

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Paul Abrams (p_abrams@bui.ac.uk), professor of urology,
Alan Wein, professor

Bristol Urological Institute, Bristol BS10 5NB

Correspondence to: P Abrams

Urology has seen dramatic changes over the past 20 years. It has moved from an open surgical specialty with few drug treatments to a specialty that has enthusiastically embraced endoscopic (minimally invasive) techniques and new drug treatments for common conditions such as erectile dysfunction and urinary incontinence. The advances that have occurred in the past few years have been mainly in treatment of diseases that are becoming more common as the population ages. These include the two most common urological malignancies, prostate and bladder cancer, as well as lower urinary tract symptoms in older men and urinary incontinence and urinary tract infections, particularly in older women.

Methods

This review concentrates on advances in urology that affect large patient groups and that are having an impact on both community and hospital practice. We have used information gained from attendance at large major urological conferences, which cover all subspecialties within urology, to help select the topics for this article. We also obtained the views of colleagues with subspecialist interests.

Urinary incontinence

There are two main types of urinary incontinence, urge incontinence and stress incontinence. Urge urinary incontinence is due to involuntary contractions of the detrusor muscle during bladder filling, whereas stress incontinence occurs when physical exertion raises the bladder pressure and is due to incompetence of the urethral sphincter mechanism.

Urge urinary incontinence is age related. Bladder training and antimuscarinic drugs remain the principal treatments. Treatment with oxybutynin is often difficult as the dose has to be titrated and it has a high incidence of troublesome side effects. Tolterodine has a similar therapeutic effect but with fewer side effects. Other new preparations such as oxybutynin extended release and propiverine also seem promising.1 In patients resistant to conservative measures, new surgical techniques such as neuromodulation (bilateral stimulation of sacral (S3) nerve roots) and detrusor myectomy …